Quantification of Lipid Filtration and the Effects on Cerebral Injury During Cardiopulmonary Bypass Richard W. Issitt, FCCP, Ian Harvey, LCCP, Bronagh.

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Presentation transcript:

Quantification of Lipid Filtration and the Effects on Cerebral Injury During Cardiopulmonary Bypass Richard W. Issitt, FCCP, Ian Harvey, LCCP, Bronagh Walsh, PhD, David Voegeli, PhD The Annals of Thoracic Surgery Volume 104, Issue 3, Pages 884-890 (September 2017) DOI: 10.1016/j.athoracsur.2017.02.022 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Lipid microemboli under microscopy. Lipid microemboli observed as nonnucleated spherical cells (red circle) taken under light microscopy with 40/0.65 optics. The Annals of Thoracic Surgery 2017 104, 884-890DOI: (10.1016/j.athoracsur.2017.02.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Before and after lipid microemboli (LME) counts. Data are presented as box and whiskers plots with boxes representing 25th to 75th centiles with median and whiskers as maximum and minimum values. Blue indicates the control group; red, the intervention group. Both groups showed significant changes in total LME counts compared with baseline and with each other (p < 0.001). The control group showed a mean increase of 115.7% in LME, and the filtration group saw an 82.8% decrease. (pre-op = preoperative.) The Annals of Thoracic Surgery 2017 104, 884-890DOI: (10.1016/j.athoracsur.2017.02.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Neuron-specific enolase (NSE) release. Data are presented as box and whiskers plots with boxes representing 25th to 75th centiles with median and whiskers as maximum and minimum values. Blue indicates the control group; red; the intervention group. Both groups saw a significant increase with peak concentrations at the end of cardiopulmonary bypass (p < 0.001); however, there was a significantly attenuated peak in the filtration group compared with the control group (p = 0.012). Repeated-measures analysis of variance showed significantly less NSE release in the filtration group throughout the sampling period (p = 0.002). (CPB = cardiopulmonary bypass; Post-op = postoperative; Pre-Op = preoperative.) The Annals of Thoracic Surgery 2017 104, 884-890DOI: (10.1016/j.athoracsur.2017.02.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The RemoweLL lipid filtration system. The RemoweLL ECC system comprising two filtering mechanisms: a leucocyte filter and a lipid microemboli siphon. A 40-μm membrane provides multilayer filtration for leukocytes and lipids, whereas the siphon, at the base of the cardiotomy reservoir, prevents the reinfusion of the lipid-rich supernatant fluid that is then discarded. The Annals of Thoracic Surgery 2017 104, 884-890DOI: (10.1016/j.athoracsur.2017.02.022) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions